- Commonwealth Care Alliance (Boston, MA)
- … Mgmt - Directs, coordinates and evaluates efficiency and productivity of utilization management functions for physical health services and long term ... a high quality team.collaboration with the broader clinical organization. - Ensures that utilization management processes are integrated with care management … more
- Commonwealth Care Alliance (Boston, MA)
- …& Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... and facilities under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and managing the daily operation of… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-oriented ** Utilization Management (UM) Nurse** . Our ideal **UM Nurse** will ensure timely ... accordance with written policy, regulatory, and Health Plan guidelines. + Apply case management skills to members who have been identified as high risk for hospital… more
- ERP International (Macdill AFB, FL)
- …International is seeking a **Registered** **Nurse (RN)** for a Full-Time position in ** Utilization Management ** at MacDill AFB, FL. Apply online today and ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- ERP International (Vandenberg AFB, CA)
- **Overview** ERP International is seeking a full-time **Registered Nurse (RN) Utilization Management ** for a temporary contract position in support of the30th ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- Houston Methodist Hospital (Houston, TX)
- …and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the ... At Houston Methodist, the Director Case Management & Social Services RN position is responsible...utilization of resources to avoid denials and resource management as it pertains to delivery of care. GROWTH/INNOVATION… more
- Alameda Health System (San Leandro, CA)
- … Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The ... clinical background. Within the last 3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required… more
- Endeavor Health (Skokie, IL)
- …(Population Health) is responsible for the case management , care coordination management , and utilization management of his/her population of patients ... for appropriate consultations and support services within established protocols Completes Utilization Management for assigned patients. Applies Milliman Care… more
- Luke Staffing (Yigo, GU)
- …of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field ... requirements of this position, it must be directly related to referral/ utilization management . + **Licensure:** Current, full, active, and unrestricted… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …assist in implementing and administering these programs along with supporting drug utilization management strategies and programs for Pharmacy, Medical Services, ... lines of business through research, analyses, and administration of clinical drug utilization management programs. + Provide clinical drug utilization … more
- Commonwealth Care Alliance (Boston, MA)
- …Work collaboratively with internal departments-including Clinical Operations, Contracting, Network Management , Utilization Management , and Business ... Abilities & Language (nice to have):** + Familiarity with care management and utilization management systems and workflows for populations with complex… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …producers, and clients about pharmacy programs and benefits. + Provide clinical drug utilization management , formulary management , and business support to ... students and/or residents as a preceptor, introducing them to drug utilization management , care management activities, product review, and program… more
- ChristianaCare (Newark, DE)
- …plan. Social Worker - Resolves psycho-social barriers and supports discharge needs. Utilization Management - Reviews patient status for appropriateness and ... and effective transitions throughout the care continuum. The Care Management Model: Our Care Management Triad Team...continuum. The Care Management Model: Our Care Management Triad Team Model is a collaboration between the… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …years nursing experience with advanced level pediatric clinical experience and utilization management and/or discharge planning experience. Thorough knowledge of ... managed care, utilization management , discharges planning, and continuous quality improvement concepts. Computer Literacy. Strong interpersonal and negotiation… more
- Commonwealth Care Alliance (Boston, MA)
- …delegated partnerships programs, working with clinical community partners responsible for care management and utilization management across CCA's One Care ... Abilities & Language (nice to have): - Familiarity with care management and utilization management systems and workflows. - Experience managing delegated… more
- MVP Health Care (Rochester, NY)
- …years of clinical nursing experience At least 2 years of experience in utilization management of sub-acute Medicare reviews Experience with Medicare guidelines ... in every interaction Your key responsibilities: Conduct timely and accurate utilization reviews for sub-acute Medicare cases. Evaluate medical necessity, level of… more
- InterDent (Portland, OR)
- …Develop, implement, and monitor clinical guidelines, quality improvement initiatives, and utilization management processes to enhance patient outcomes and ... best practices Lead hiring, onboarding, training, mentoring, and performance management of dentists and hygienists Evaluate clinical performance and...optimize resource utilization . Lead efforts in achieving quality performance targets, including… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- …ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. ... Client Name Providence Little Company of Mary Medical Center San Pedro- Case Management Job Type Travel Offering Nursing Profession RN Specialty Case Manager Job ID… more
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